Two surgical techniques are currently in use for ureterostomies.
The first technique, known as the Bricker technique, creates an artificial connection between the ureter or ureters to be treated and a fragment of ileum; the isolated fragment of ileum is connected to the skin for discharging the urine going through it, as a consequence of the anastomosis of the ureter or ureters to this fragment. The second technique involves the direct connection of one or both ureters to the skin. Each of these techniques has disadvantages. The first technique is more complicated; furthermore, it can cause ionic imbalance due to reabsorption of various ions through the ileum. Where there is a significant loss of potassium, the organic disorders can cause damages to a greater or lesser extent.
The second technique of cutaneous ureterostomy is surgically simpler, but there is a significant risk of stenosis of the part of the ureter connected to the skin; it has thus been recommended to insert a catheter into this stoma, which catheter must be held in place by some means. These insertions are relatively precarious and the source of many problems.
Furthermore, the urine is discharged into collecting bags which either are fixed directly on the skin around the stoma by means of an adhesive compound placed on the outer face of the bag, or are attached by way of a plate bearing a gum which adheres to the skin, to which plate the collecting bag will be attached by sticking or by a locking system. These devices have numerous disadvantages when used: irritation of the skin due to periodical withdrawal of the bags for hygienic reasons, stoma dimensions non adapted to collecting bag opening diameter, and, above all, problems due to attack by the urine which, when it comes into contact with the adhesive material, unsticks it or results in the loss of adhesive gum properties or even dissolves it.
The device according to the invention, which can be used in the case of cutaneous ureterostomies, eliminates the abovementioned disadvantages and enables the second surgical technique to be used, which is simpler and less detrimental to the patient than the first. For cutaneous ureterostomies, it has also been recommended, for discharging the urine, to implant surgically a device, such as that described in patent FR-A-2,511,240, which is composed of a tube with anchoring points. Such a device, which is irremovable without a further surgical operation, will suffer obvious disadvantages from prolonged use, even when made from fully biocompatible materials; moreover, in the case where a second ureterostomy has to be performed after the first, the latter will have to be reoperated to implant the two-branched device described in the patent application.
Moreover, a device, such as that described in U.S. Pat. No. 3,884,235 for ileostomies and colostomies, is not applicable in the case of ureterostomies. Whereas the system comprising a collecting bag equipped with a connector is sufficiently watertight for collector material of low fluidity issuing from the ileum, this is not the case for the collection of urine; sealing is, in fact, only provided through the contact between the connector and the inside of the ileal passage.